Bariatric Surgery

Bariatric surgery is known to be one of the most effective methods to aid and maintain weight loss. It can prevent future health problems, improve quality of life and increase life expectancy.

Related Information

Introduction

The Mater Private Bariatric Programme is a fully integrated bariatric programme. It is led by a highly experienced consultant Surgeon and supported by a multi-disciplinary team of healthcare professionals. This team review every patient to determine their suitability for surgery and support them before, during and after surgery.

About bariatric surgery

You may have been dieting for much of your life, have never dieted or find it difficult to maintain weight loss. Maybe your GP has referred you for bariatric surgery as the best option for you. Whatever the reasons, the first step is finding out more to decide if bariatric surgery is right for you.

Bariatric surgery can also be referred to as obesity surgery, metabolic surgery or weight loss surgery. There are different procedures, and your Surgeon will discuss which is the best option for you:

Bariatric surgery operations may reduce your hunger, restrict the amount of food you are able to eat or reduce the amount of food you can absorb. It is non-reversible and designed to help you to reduce weight. Bariatric surgery does not include procedures which remove fat from the body, such as liposuction or abdominoplasty (tummy tuck).

Obesity and health problems

Obesity can contribute to many other health problems and can shorten your life expectancy.

How can I be referred to the Mater Private Bariatric Programme?

Your GP can refer you to be considered for weight loss surgery. Surgery is an option if you are obese, motivated, and have realistic expectations about what surgery can achieve for you.

    • Have a BMI of 45 kg/m2 or more OR have a BMI of between 40 kg/m2 and 45 kg/m2 with another significant disease (e.g. Type 2 diabetes)
    • Have failed to achieve or maintain clinically beneficial weight loss using other non-surgical measures
    • Be willing to see the specialists that are recommended and follow their instructions
    • Be generally fit for anaesthesia and surgery
    • Be committed to long-term follow-up care with the Bariatric team

The Mater Private Bariatric team

As part of the programme, you will undergo a comprehensive team assessment which lasts a minimum of six months. The team will work with you to develop a long term weight loss plan and will continue to support you after surgery.

Committing to changing your diet, exercise and lifestyle for life is the most likely method for success. This is not always easy but the team will help you to introduce these changes.

Procedures

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Preparing Yourself

Dietary, exercise and lifestyle changes are part of the bariatric surgery process. It is important to have a support system prepared. We recommend that you start gradually following the diet rules and mentally prepare for changes to your lifestyle and habits post-surgery. Find more information below on making your choice and what to expect.

What to expect

It is common to lose weight quite quickly over the first year following bariatric surgery. A Dietitian will recommend changes to your diet and eating patterns to achieve the best results. Most people lose at least 50–60% of their excess body weight. Surgery will not necessarily get you back within the healthy weight range (BMI of 20–25kg/m2) but it will get you closer to it.

Support & commitment

You should continue with any support groups you have found successful for weight loss. If you haven’t used a support group, you should consider joining one as it can be an invaluable support and motivator.

Bariatric surgery is not a quick fix option and making the decision to have surgery is a serious step. If you do not follow the advice of our teams, weight gain can occur 12 to 18 months after surgery.

Preparing for change and rules for eating

Gradually preparing yourself for changes to your habits before the surgery happens will make it much less daunting. For surgery to be successful there are a number of ‘rules’ you will need to follow. We suggest that you start following these rules before surgery to help you get used to them.

    • Eat slowly to avoid overfilling your small pouch/sleeve which can cause vomiting. Aim for bites the size of your thumbnail or a teaspoon.
    • Chew well to avoid food pieces becoming lodged at the bottom of your pouch/sleeve which causes discomfort and can lead to regurgitation.
    • Do not drink with your meals. Fluid can overfill your pouch/sleeve and lead to vomiting. It can also dilute your meals and push them through your pouch/sleeve quickly, which means you do not feel full. Stop drinking 10 minutes before you eat, and wait 30 minutes after eating to drink.
    • Eat regularly. This results in more weight loss than if you eat irregularly or snack.
    • Eat small portions as it takes a while for your brain to adjust to the small size of your pouch/sleeve.
    • Mentally prepare. Analyse your eating behaviour and any triggers for overeating. Look for ways to avoid triggers or alternative ways of coping other than eating.

Making the choice

You may have many questions. Talk to the Mater Private Bariatric team, family and friends, research online – whatever allows you to make an informed decision. Surgery will be a shared decision between you, the Surgeon and the team.

Other considerations

  • Following weight loss surgery, it is important that you can chew your food well. If you have dental problems and particularly if you are missing back teeth, you will need to see a dentist prior to surgery.

  • Smoking is associated with higher risk of anastomotic leaks and ulceration after surgery. You will not be eligible for bariatric surgery if you are actively smoking.

  • We recommend that you do not become pregnant while you are rapidly losing weight. Your body may not get all the essential nutrients for your baby to be healthy. Barrier methods of contraception (e.g. condoms) are compulsory for 18 months following surgery, particularly as you are likely to become more fertile when you lose weight.

  • This is not unusual. Your Surgeon will discuss your individual level of risk with you.

  • If you have had one or more surgeries of your abdomen, you may need open surgery rather than keyhole surgery.

  • Laparoscopic sleeve gastrectomy is permanent and irreversible. Roux –en-Y can be reversed under exceptional circumstances but requires complex, major surgery. You will need to attend regular hospital appointments after your surgery to ensure you are losing weight safely.

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The Surgery Journey

Below you will find details on the surgery journey from the assessments before being admitted to what will happen post-surgery. It is important that you inform yourself on the full process as there are many steps. Becoming aware of what will happen and what will be expected of you should help in making your decision.

Stage one

Getting Started

There are many steps involved in the 6 months before surgery. This is to ensure that you get the best care possible, appropriate to your needs. Your diet, nutrition and current health status will all be thoroughly reviewed at screening appointments.

  • At your first appointment, the team will discuss the surgery and explain in detail what is involved. You will complete a questionnaire in advance. This will be reviewed along with your medical history, weight loss history and eating habits.

    After this initial appointment, you may be referred to other members of the team for review. Once these reviews take place you will see your Surgeon again to decide whether to proceed.

  • Many patients benefit from some psychological support before and after surgery. At the initial assessment your expectations of surgery will be discussed, as well as the emotional factors that might affect your eating. The aim of this assessment is to think about whether surgery is the best option for you, and how you will cope with the necessary lifestyle changes.

  • You will meet the Dietitian at your initial assessment. They ensure you are well informed for the dietary and lifestyle changes you will need to make. Your expected weight loss following surgery will be calculated.

    You will see the Dietitian at frequent intervals over a two year period to make sure you have adequate nutrition and are being consistent.

  • You will be given an appointment to attend a Pre-operative Assessment Clinic in the hospital. This clinic includes final checks to assess your fitness for surgery including standard blood tests, screening for MRSA and ECG of the heart.

  • Patients with a pre-existing illness are at a higher risk of developing complications during or after surgery. The following may be required:

    • ECHO, ECG or stress test if you are at risk of developing heart failure, a heart attack or other heart disease.
    • Endoscop if you have a history of acid reflux or upper gastrointestinal tract disease.
    • Anaesthesia assessment if you are assessed as high risk by the anaesthesia team.
    • Respiratory/sleep clinic if you have sleep apnoea.
  • Many patients needing bariatric surgery have a large, fatty liver which can cause difficulty for keyhole surgery. These patients will be required to follow a strict diet that is low in dietary carbohydrate and fat for two weeks prior to surgery, thus helping to shrink the size of the liver.

    It is essential that you follow this diet. If you have not followed it prior to surgery, your surgery may be cancelled.

Stage two

Preparing for Admission

You will be given a date for admission once your assessments have been completed and the team agree that you are fit for surgery. Once you have a date for surgery, you should make arrangements prior to being admitted to hospital.

    • Transport to and from hospital
    • Help at home for the first few weeks after surgery
    • Prepare and freeze meals from your diet sheet to make the transition to your new diet easier
    • Plan for coping strategies to deal with emotional eating

Stage three

The Surgery

It is best to be as prepared as possible for the day of the surgery. The details below explain what will happen once you are admitted to the hospital for your surgery.

  • Most people are asked to arrive on the morning of their surgery. If you are diabetic, you may be admitted the day before surgery to stabilise your blood sugar levels while you are fasting. You will be advised to stop taking aspirin or blood thinning medications one week prior to surgery. You should bring toiletries, nightclothes/tracksuits, slippers and any medications you are currently taking.

    If you use a CPAP or Bilevel Positive Airway Pressure machine for sleep apnoea at home it is essential that you bring this with you. You will be asked to fast from food and drink from the night before your surgery - you may take essential medications (such as cardiac drugs) with small sips of water.

    You will be seen by the anaesthetist and the surgical team before you go to theatre—they will answer any further questions and confirm that it is safe to proceed with your surgery. You will be accompanied by a nurse from the ward to theatre where you will have your anaesthetic.

  • You will:

    • Return to the ward after a short period in recovery
    • Have a drip to provide hydration and you may have a patient controlled analgesia pump (PCA)
    • Be allowed small sips of water the night after your surgery
    • Have a swallow test the day after surgery in the X-ray department
    • Be visited by a Dietitian after surgery who will advise you regarding starting fluids and your diet after discharge
    • Be encouraged to get out of bed and start walking as soon as possible, as this will aid your recovery
    • Be provided with painkillers and medication to stop you feeling sick

Stage four

Post-surgery

On average patients stay in hospital for 2-5 days. The following outlines the advice and timelines you should follow to encourage a safe recovery.

  • Wounds: The ward staff will advise you about wound care before you go home. If you have stitches that need to be removed, the ward staff will give you a letter for your GP or practice nurse to arrange their removal.

    Medication: Your medication will be reviewed by the medical team before you go home. You may be given a supply of medication to take home with you. This could include pain relief, anti-sickness medication, or nutritional supplements. You may be given a two-week supply of blood thinning injections (heparin). You will be taught how to inject yourself by the ward nurse.

    Eating and drinking: Follow the guidance provided by the Surgeon and the Dietitian.

    Washing: You can shower, but we do not recommend taking a bath for at least a week after surgery.

    Driving: We recommend you do not drive until you can safely brake without any abdominal pain (usually after six weeks). You should check with your insurance company for their specific advice about driving after keyhole surgery.

    Exercise: You will be able to start getting up and walking the day after surgery. You can exercising about six weeks after the operation, although gentle exercise such as walking can be done as soon as you feel it is appropriate.

    Returning to work: Most people are able to return to work a couple of weeks after surgery. We recommend no heavy lifting or strenuous activity for six weeks after the operation. If you need a sick certificate for your employer please make sure you ask the medical staff prior to your discharge.

  • Two weeks after surgery you will be sent follow up appointments to see the Surgeon and the Dietitian. You will then be seen regularly for 18 months by members of the multi-disciplinary team. If you have not received appointments in the post or by email, please contact the Dietitian or Nurse and they will check if this has been arranged for you.

    You will see the Dietitian regularly for the first year following surgery, and every 6–12 months thereafter. If you are having difficulties or want to see the Dietitian more regularly, this can be arranged.

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